A new multidimensional instrument for preventive in-home assessments in older people: results of a pilot test

Preventive home visits with multidimensional geriatric assessment have been shown to delay or prevent the onset of disability and reduce nursing home admissions in older people. The purpose of the present study was to develop and test a multidimensional instrument for in-home preventive assessments in older persons. In developing the instrument, we conducted a systematic l iterature review of risk factors for functional status decline and of appro priate instruments for measuring these risk factors. Based on an Expert Pan el using a modified Delphi process [1] the risk factor domains for function al status decline were chosen, [2] the instruments for evaluating each of t he included risk factor domains were selected, and [3] the individual instr uments were combined into one comprehensive assessment instrument. A German language version of the original English version of the instrument was dev eloped based on translation, backtranslation, and cultural adaptation. The feasibility of use of the new instrument was evaluated in a field test in 1 50 people aged 75 years and older in Hamburg, Ulm, Germany, and Bern, Switz erland. The instrument was well accepted by the older persons. The prevalen ce of risk factors for functional status decline in these populations (e.g. , physical inactivity, urinary incontinence, vision impairment) was high. T here was also a high prevalence of underuse of preventive care measures (e. g., no pneumococcal vaccination in over 95 percent of persons). These preli minary results support the possible usefulness of this instrument for condu cting preventive home visits or for epidemiological purposes (e. g., preven tion surveillance). In a next phase, the test-retest reliability of the ins trument, and the feasibility and reliability of self-administration as comp ared to interviewer administration will be described in a separate paper.